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目的探讨腹腔镜阑尾切除术(laparoscopic appendectomy,LA)治疗小儿阑尾炎并穿孔的安全性和可行性。重点探讨腹腔镜治疗的综合疗效。方法小儿阑尾炎并穿孔48例,男28例,女20例。年龄4～12岁。化脓性并穿孔29例,坏疽穿孔19例,所有患者在术后均经病理检查证实。全部病例采取紧闭式气管内麻醉,造成人工气腹,使用电视腹腔镜,以内凝或电凝及套扎方法完成阑尾切除术。结果全部病例手术过程顺利,手术时间25～60min,平均(40.13±9.86)min,平均下床活动时间(12.10±2.21)h,平均出院时间(4.29±1.25)d,伤口无一例感染,无其他并发症。结论腹腔镜阑尾切除术治疗小儿穿孔性阑尾炎具有创伤小、恢复快,并发症少和平均住院时间短等优点,是治疗小儿穿孔性阑尾炎理想的手术方式。
Objective To investigate the safety and feasibility of laparoscopic appendectomy (LA) for perforation of pediatric appendicitis. Focus on the comprehensive effect of laparoscopic treatment. Methods Pediatric appendicitis and perforated 48 cases, 28 males and 20 females. Age 4 to 12 years old. Purulent and perforation in 29 cases, 19 cases of gangrene perforation, all patients were confirmed by pathological examination after surgery. Totally closed endotracheal anesthesia was used in all the cases, resulting in artificial pneumoperitoneum. Laparoscopy was performed on the TV sets to complete appendectomy with coagulation or electrocoagulation and ligation. Results The operation procedure was successful in all cases. The operation time was 25-60 minutes (mean, 40.13 ± 9.86) min, mean time to bed ambulation (12.10 ± 2.21) h, average discharge time (4.29 ± 1.25) d, no wound infection complication. Conclusion Laparoscopic appendectomy for perforation appendicitis in children with trauma, rapid recovery, fewer complications and shorter average length of stay, etc., is the ideal surgical treatment of perforated appendicitis in children.